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Friday, July 9, 2010

Part One. Interview with Arnold Milstein, MD, Health Care Innovator.Health Improvement Activist, Co-Founder, Pacific Business Group on Health and Leap

Part One. Interview with Arnold Milstein, MD, Co-Founder, Pacific Business Group on Health and Leapfrog Group, Professor of Medicine, Stanford

Ambitions and Objectives at Stanford

Preface:Mercer Chief Physician and US Health Care Thought Leader Arnold Milstein, MD, has been appointed a tenured Professor of Medicine at Stanford University, where he will establish a new research center dedicated to accelerating innovations in health care delivery in the US and globally that improve the value of health care.

Because of its length, this interview will appear in four parts. Part One, Ambitions and Objectives at Stanford; Part Two. . The Potential Role of Government and Impact of Health Reform Law; Part Three. Clinical Innovation Business and Care Models; Part Four, Other Clinical Models Lending Themselves to Accountability. What Dr. Milstein is saying takes time to digest and is best read in three parts to leave time for pondering. ____________________________________________________________________________________

Q: Dr. Milstein, I am conducting this interview on behalf of The Physicians Foundation, which represents all physicians in state medical societies, most of whom are in physician-owned independent practices. The interview will appear in my blog, ReeceMD.com, and in modernmedicine.com. As for myself, I have recently written two books, Innovation-Driven Health Care and Obama, Doctors, and Health Reform. My main interests are innovation and reform. Dr. Milstein, what is your present title and your forthcoming title at Stanford University.

A: I am currently the Chief Physician at Mercer Health and Benefits and Medical Director of the Pacific Business Group on Health. Beginning in July, I will be a Professor of Medicine at Stanford, remain medical director of the Pacific Business Group on Health and maintain a part-time connection to Mercer.

Q: What are your ambitions at Stanford? What do you hope to accomplish there?

A: At Stanford, I will found and support the development of a new research center. The center will bring together three different sciences in an effort to hypothesize and then test, better, more affordable ways of producing health: engineering science, management science, and medical science.

Q: Stanford has a glittering reputation in all three of these disciplines. It produces a host of innovative information technology graduates, including the two founders of Google. It is cheek to jowl with Silicon Valley, which has an innovative culture all of its own. Are you excited about your new job?

A: I am. Stanford offers globally recognized engineering, business, and medical schools within a ten minute walk of each other. In addition, Stanford has been a long-standing contributor to innovation and entrepreneurship in America’s IT and bioscience industries and more broadly to global prosperity that depends on knowledge creation.

Q: I am conscious of the scope of your work at the Pacific Group on Health, your co-founding of the Leapfrog Group, your articles on medical tourism and Medicare “never events”, and your service on the Medicare Payment Advisory Commission (MEDPAC). I begin with knowledge of your work. You are considered America’s leading activist specializing in health care improvement. What do you hope to achieve in your new position at Stanford?

A: Our first objective is a research objective- to mobilize a more disciplined scientific effort to accelerate improvement in the value of health care, first for the U.S. population and over time, for the world population.

Our second objective is a service objective. The tests of the new care designs will typically be at Stanford-affiliated clinics and hospitals. If the test results demonstrate more value for patients and payers, then we will test their replicability more widely.

Our third objective is to transform our discovery process into useful educational experiences for students in clinical and pre-clinical training, since continuous study and redesign of care needs to become a much more prominent component of the professional identity of health care professionals.

11 comments:

While I suspect that such research is necessary and may be useful, if the good Professor is going to try to develop a model of care where care is "free" for the patient (consumer) and cost containment is the responsibility of the doctor, insurer, government or some other agency or organization it will fail. Ironically, the single most important policy that has driven patients to cost effective generic drugs, the Medicare Part D "donut hole" was repealled in the HCR bill. Without the donut hole, No one is going to ask to change from expensive Lipitor to generic simvastatin. I believe this is a cynical political "poison pill" added to the bill to prevent wholesale repeal of the bill for fear of taking something away from the AARP set. The models to control costs and ensure quality are already available, high deductible HSA-linked insurance. I have already seen this model resulting in significant decrease in utilization where I work, the East Bay. The decrease has affected specialists so much they are getting more and more bold with unecessary testing on Medicare patients (no significant cost to the patient, no prior auth required). Of course it's much more fun to give away care for free and then blame the doctors for overutilization. As a member of the MEDPAC, which has systematically destroyed primary care in this country (the midlevels haven't stepped up and the physicians are dwindling) I suspect the good Professors research will result in a great big waste of time and money. Patients get treated by doctors who work in offices and hospitals who expect a decent salary for a 60 hour work week - not by Stanford MEDPAC paper pushing policy researchers. I predict that in 5 years or less most doctors will have abandoned Medicare and private insurance for cash pay and offer enhanced service, more time and higher quality and satisfaction. The PBGH should have figured this out many years ago.

I do not necessarily agree with everyone I interview. But I think it is worthwhile getting a broader perspective. I agree with you the health care law hurts HSA growth, which has proven to be effective in controlling costs. I also agree more free entitlement programs will raise costs and drive doctors out of Medicare.

The Health Reform Maze

Buy the Book

Book Description: In this first book in a series of four, Richard L. Reece, MD. provides a unique view of the roll out, and run up, of the Affordable Care Act. Reece shows in this book the progress and facets of ObamaCare's marketers and messengers, as the day approached for the launch of health insurance exchanges - the single most public and problematic portion of the new law. This is a must read for anyone who wants to chronicle this attempt to organize more than one-sixth of the U.S. economy by adding layers of federal government control and regulations.

Reece has been writing about U.S. health care for more than 45 years. His knowledge and experience, added to his keen intellect and gift of subtle humor, make this book a valuable part of anyone's collection.